MINIMAL CHANGE DISEASE AND ACUTE TUBULAR NECROSIS CAUSED BY DICLOFENAC

Abstract

Renal side-effects of anti-inflammatory drugs (NSAID) can be diveded in five clinical syndromes: acute renal failure, acute intersticial nephritis with nephrotic syndrome, electrolyte and fluid disorders, hypertension and analgetic nephropathy.We described one unusual combination of acute tubular necrosis (ATN) and minimal change disease (MCD). Reports of ATN and MCD with nephrotic syndrome caused by NSAID exposure are very rare. This is the first reported case of MCD associated with ATN by Diclofenac. A 53-year-old woman with acute renal failure (creatinine was 716 μ mol/L) and nephrotic syndrome (she was in generalizied oedema and protein excretion was 6.0g/day) was admitted to our hospital. She also had eosinophilia. Her medical history was unremarkable except for nontreated hypertension for five years. Only medication she has been taking was Diclofenac for chronic muscular pain and knee arthropathy. NSAID drugs exert their toxic effect on the kidney by ihibition of prostaglandin synthesis and causing an acute allergic interstitial nephritis. The pathogenesis of NSAID-associated MCD is unclear. NSAID drugs cause inhibiton of cyclooxigenase and shift arachidonic acid toward lipooxygenase pathway, which may result in enhanced production of proinflammatory leukotriens. In addition, lypooxigenase products increase vascular permeability and may contribute by altering glomerular-cappilary barrier. The patient was treated with steroides. The response was excellent with remission of nephrotic syndrome and the normalization of renal excretory function within 6 weeks.